Critical Care Newsline — April 30, 2009

Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by AACN’s clinical practice experts. In each issue, you’ll find links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and Web sites that will keep you informed on issues affecting nurses and the nursing profession.

1.RESOURCE: Protocol Leads to Greater Mobility, Shorter Hospital Stay for Respiratory ICU PatientsAn early-mobility protocol developed by an RICU nurse manager that resulted in shorter hospital stays for respiratory patients is posted on the AHRQ Healthcare Innovations Exchange. A prospective cohort study showed the vast majority (almost 98 percent) of participating patients completed at least one step in the protocol, and more than two-thirds successfully walked more than 100 feet. Since implementation, ICU and total hospital length of stay for respiratory failure patients declined; rates of weaning failure and use of tracheotomies also decreased.

2. EVIDENCE Managing Type 2 Diabetes: Customized Treatments May Be More Effective, Study ShowsAlthough physicians typically prescribe tight glycemic control for patients with type 2 diabetes, this treatment often requires highly complex regimens resulting in patients’ frustration, lack of adherence and financial stress. After reviewing clinical trials comparing glycemic control regimens, researchers developed practical suggestions for managing these patients. According to the authors, physicians should individualize drug treatment approaches to help patients achieve a blood glucose level balancing medication levels with a reduction in symptoms and complications. The authors advocate tools and tactics that encourage patient involvement in treatment decisions, because they may lead to treatment programs that are evidence-based and consistent with patients' lifestyles and informed values.

3.EVIDENCE Online Reporting System Tracks Surgical ComplicationsA Web-based reporting system may help clinicians track surgical complications and detect patterns of adverse events, identifying opportunities to improve the quality of care, according to a recent study. The system was implemented at a large metropolitan tertiary care center in September 2005. Residents entered data about adverse events used for the morbidity and mortality conference, and all clinicians in the surgery department were given a password to anonymously enter information about other adverse events and near misses. "An electronic physician-reported event tracking system should be incorporated into all surgery departments … this is just one component of what should be a larger quality improvement effort," the authors conclude. "An online event tracking system is a feasible, promising and potentially powerful initiative to improve surgical safety in the United States."

4. ADVISORY FDA Adopts Interim Plan to Avoid Shortage of Medically Necessary OpioidThe U.S Food and Drug Administration recently amended its action last month warning manufacturers to stop the production and distribution of certain unapproved prescription opioids, to allow the continued marketing and distribution of one particular type -- a high concentrate morphine sulfate oral solution -- on an interim basis. The FDA took this action in response to concerns from patients and healthcare professionals in the palliative care community that would cause a shortage of 20 mg/ml morphine sulfate oral solution. This product is widely used to alleviate pain in terminally-ill patients. The agency has determined that this dosage form is medically necessary, and should remain on the market until an approved alternative becomes available to the patients that need it. To learn more about the FDA’s initiative against unapproved drugs, refer to the agency’s Compliance Policy Guide.

5. NEWS This Month's AJCC OnlineFirst Articles Now Available This month's Publish Ahead of Print articles are now live on the American Journal of Critical Care Web site. Click the OnlineFirst logo to read a descriptive evaluation of current practice in airway management among registered nurses and respiratory therapists, and the case of a pediatric patient whose nasogastric tube became knotted with his nasotracheal tube, causing hypercapnia. Log-in required to read articles; abstracts are free access.

6. RESOURCE Spanish-language Version of HAI Patient Guide AvailableThe HAI Patient Guide, developed by the SHEA Patient Safety and Quality Improvement Committee in collaboration with the CDC, is now available in Spanish. The resource contains information on surgical site, central line-associated bloodstream and catheter-associated urinary tract infections, ventilator-associated pneumonia, Clostridium difficile and methicillin-resistant Staphylococcus aureus.

7.CALL FOR ABSTRACTS Live Educational Sessions for NTI 2010 in Washington, D.C.AACN is accepting abstracts for live educational sessions to be presented at NTI 2010. Abstracts selected for presentation must reflect AACN’s mission, vision and values; support AACN’s major areas of interest; link research and practice; present cutting edge information and contain precise, comprehensive content. The deadline is June 1, 2009.

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